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Home My WebLink About11-040 _�,`_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 . . _, (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS '9�"� BUILDING PERMIT APPLICATION FIRMLY y�, JOBSITE .-�_,/�� )��K ,�� APPLICATION PERMIT 'f,_O Op/� ¢ ADDRESS �';�7 � DATE NUMBER�_� p � ISSUE / l` TYPE r OCC � APN LOT TRACT DATE �/�/�y// CONST. ��/ GROUP p OWNER ��R� (Qf� p ADDRESS � ZONING SEfBACKS FRONT Z CITY � ZIP G,�9 TEL. " � -G10 RW O � APPLICANT TEL. REAR � �� SIDE/SIDE STREET RW ❑ CONTRACTOR SO ,e SIDE p ADDRE S � CITY ZIP Q��EL. PROPOSED USE ' w ARCWENG/ (-�T �� `Y. z DESIGNER A� �i - a ADDRESS � NO.DWEL. O. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNEF•BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDER PENALTV OF PERIURV TFUT I AM EXEMPT FAOM THE CANTRACTOPS LI� G8le0B/COfPOfI W CENSEUWFORTHEFOILOWINOREASON(SEC.7031.68USINESSANDPROFESSIONSCODE:ANYCITVOR (f� U �p�JrJJyWF{ICHREOUIqESAPEfiMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORflEPAIRANVSTRUG W w NRE,PRqp TO RS ISSUANCE.AL50 REOUIRES THE APPLICANT FOR SUpi PERMIT TO FILE A SIONED w Petlo/Deck � STATEMENT THAT HE OR SHE IS UCENSEO PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI- � CENSE UW(CHA➢TER Y(COMMENCWO WITH SECTION]000)OF DIVISION 3 OF THE 9USINE55 ANO Pq0- u' POOVSPB , O FE5910NSCOOE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTMEBASISFORTHEALLEOEDEXEMP� C7 V TqN.ANVV10l.ATIONOFSECTION7031.SBVANVAPPLICANTFORAPERMIT CTSiHEAPPLICANTTO Z Re-Roof A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f50D).): � ❑I,ASOWNEROFTHEPpOPERTY,ORMVEMPLOYEESWITHWAOE THEIRSOLECOMPENSATION, � COrtIrtIB�C18I Z WIIL DO THE WORK,AND 7HE S7RUCTURE IS NO7 INTENDED OR RED FOR SALE(SEC.7ou,BU51� J � NESS AND PROFESSlONS CODE:THE CAMTRACTORS LICENSE DOES NOT APPLV TO AN OWNER OF j PROPEHTY NM1iO BUILOS OR IMPROVES h7EREON,AND WH ES SUCH WORK HIMSELF OR HEPSELF OR CC THROUGH HIS OR HER OWN EMPLOVEES,PqOVIDED SUCH IMPROVEMENTS AFE NOT INTENDED OR m 0 OFFEREDFORSALEIF,HOWEVER,7HEBUILAIN00 ROVEMENTISSOLDWRHINONEYEAROFCAMPLE- I Z TqN,THE OWNER-BUILDER WILL HAVE THE B EN OF PROVING THAT HE OR SHE DID NOT BUILD OH � IMPROVE FOfi THE PURPOSE OF SALE). W ❑I,ASOWNEROFTHEPROPEHTV EJ(CLUSNELVCOMRACTINGWfTHLICENSEDCONTMCTORS I � TO CONSTRUCT THE PRpIECT(SE ,BUSINESS AN�PROFESSIONS CADE THE CONTMCTORS U- V8W8�1Of1 � qp�.qqE,q W CENSE UW DOES NOTAPPLY T OWNER OF A PHOPERTV W/10 BUILDS OR IMPROVES THEREON,AND � WHOCAH�MCTSFORSUCH QIECTSWITHACONTRACTOq(S�LICENSEDPURSUMITTOTHECONTRAG QUANTITY DESCRIPTION TORS UCENSE UW.�. FEE � ❑I AM EXEMP NDER SEC. B.8 P.C.FOR THIS REASON � ' � U u' DATE ONMER � Z U � UCENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � �(COMMENCING WRH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z �� MY LICENSE IS M FULL FORCE AND EFFECT. m � UCENSE CLASS �_ LIC.NO.��% �1 � U DATE ` �� I�_ CONTRACTOR_ a LLI � WORKERS'COMPENSATION DEC R TI N Q U � 1 HEFEBV AFFIRM UNDER PENALTV OF 7ERJURV ONE OF THE FOLLOWING DECURATIONS: Z , � _IHAVEANDWILLMAINTAINACERTIFICATEOFCON6ENTTOSELF�INSUREFORWORKERS' a 2 Q COMPENSATION,AS PROVIDED BV SECTION 37o00F THE LABOR CODE,FOR TME PERFORMANCE U OF hIE WOAK FOR WHlpi THIS PERMIT IS ISSUED. ' W 0 � Qw _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIRED BV SECTION 37aa OF THE LABOR CODE,FOR T11E PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ��`�� ISSUED.MV WORKERS'.COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: NSTRUCTIO __ '! CAARiER PLAN REVIEW Z POLICV NUMBER � '� �p�=rP� ELECTRIC Q 0 (iHI55ECTqNNE�NOTBEWNA.ETEDOFh�PEPoNTISFOqONEI-0..rDFEDDCLLNiSK10D)ORLESS} PLUMBING W Z 1 CERTIFY THAT IN THE PERFORAIANCE OF THE WOHN FOR WHICN THIS PERMIT IS ISSUEO,I MECHANICAL L'} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE (n WORKERS'COMPENSATION LAWS OF CALIFORNIA ANO AQREE THAT IF I SHOULD BECOME INSPECTI FEE SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR �� O CODE,I SHALL FORTHWITH COMPLY WITH T SE PROVISIONS. ISSUANCE p DATE: � � qPPLICANP. SMIP p�{,./ W J WARNINO:FAILURE TO SECURE WORKERS'COMPE ATI N COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C J � SU&IECTANEMPLOVERTOCflIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHWSMID ENERGYPERMIT DOLLAAS(ttao,00a),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PHOVIDED FOR IN � � SECTION 37oe OF THE LABOR CODE,INTEREST,AND ATTORNEI"5 FEES. ENTIO F �� OCONSTRUCTION LENDING AGENCY pqF_q�,�E � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS UCTION LENDING AOENCV ��J�� FOR THE PERFORMANCE OF THE WORK FOR WHICH THI IS ISSU�CIV.C.). �� Z W � LENDER'S NAME . ~ LENDER'SADDRE55 � w I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE A60VE INFORMATKKJ IS CORRECT. TOTAL FE ES /�� J V � 1 AGREE TO COMPLV WITH AlL CITY AND COUNTV ORDINANCES AN�STATE LAWS REUTINO TO BUILDINO � CONSTRUCT{ON,AND HEREBV AUTFIORIZE REPRESENTATNES OFTHIS CWNTV TO ENTER UPON THE - Z ABOVE�MENTbNED PROPERTV FOR INSPECTbN PURPOSES. p �� COMMENTS � J � m PERMITT� .NAME PRIPIT) � . Q ��I�� 51(3NA I EE DATE = RECPT.NO. PAID BV VALIDATION ~ WHITE—Department Co YELLOW�inence py, Copy,PINK—Asaessor Copy,GOLDENROD—File Copy,GREEN—Appli t's Copy CITV O� DlAfViO�D B,�R II�S��CTEO� FiECORD � � � �..,, , , , . , �� • �. - a�p��400a - �� ? �..; .� ��' ��p ,__� . _. .� . o"_ .�t��o�=�� .. o - . � - b, d. , , , o ,�.�. SET BACK FLOOR JOIST � FTGS/FORMS/STEEL '-`� FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FiREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID H'T. BOND BEAM • ROOF SHEATHING 8 FT. BOND BEAM � � FRAMINGNENTILATION • � � FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEIIING INSULATION QFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY `�� . COMMEIVTS � �' ��°�'`— � �g ` SEPTIC TANK SIZE SEEP PIT/U SIZE �� a �: 9� � :y��; -�- �..� �-s �r}� :II , �� , . .. � ��_ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 . � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 � PRESS ' ��'°^'�W BUILDING PERMIT APPLICATION FIRMLY y JOBSITE �; APPLICATION PERMIT � ADDRESS �t��'��'.,: '��rD2�� j�L� DATE NUMBER�� '��' #/C � APN LOT TRACT D TEE ��'�� ' �,� CONST.,�`,�'� ,`,�'�, t Q ��,�� '"�+� GROUP p OWNER �` ADDRESS '' ZONING SETBACKS 0 Z CITY ZIP r TEL.. ;:�:;"" FRONT q�y p o APPLICANT TEL. y � S DE/SIDE STREET RW ❑ � CONTRACTORT�:?�L":a'?{'4.,C`,g'. 7"R'=i,i:�l �� j,�. � �r!,,;ti„J.` .��lu SIDE ❑ ADDRESS ri .�=* 1' ,::r r.: ,t i ,r�,.-.� O ,.•� !,�' PROPOSED USE flx.� Lt t. ?�•:-+3,�' �•i-1' ��'`-i- � C_r'-, «� „%{ CITY# �. �.E n:� � i.- �ZIP 7.-,: �_,SEL. � 3 w ARCH/ENG/ / � ' "' " ' '+ -' � � � /, 1>*�r.;` • - � z DESIGNER s i �' �� l. �."": Y ��;', a ADDRESS '�' .l r NO.DWEL. '�LNO. f NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS u� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O � 1 HEREBV AFFIRM UNDER PENALTY OF PEfLA1RV THAT I AM E%EMPT FROA/THE CONiRACTORS U- GBfe(JB/C8lPOfI W CENSEUWFORTHEFOI.LOWWOREASON(SEC.7031.SBUSWESSANDPROFESS�pMSCODE:ANVCITYOR (n U �p�lry7`/WHICHREOUIRESAGERMITTOCONSTFiUCT,ALTER,IMPROVE,DEMOlISH,ORREPAIRANYSTRUC- P8110/DBCK w NRE,PRIOR TO ITS ISSUANCE,KSO REIXlIqES THE APPUCANT FOH SUCH PERMIT TO FILE A SIONED w � STATEMENT hIAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll� � CENSE UW(CHAPTER 9(COMIdENCWG WITH SECTION 7000)OF DIVISION�OF THE BUSINE55 AND PR0. � POOUSPB . � FESSqNS COD�OR THA7 HE OR SHE IS E%EMP77HEREFROM AND THE BASIS FOR 7HEALLEOEO E%EMP� (� U TION.ANVVIOLATIONOFSECTION70.71.6BVANVAPPLICPNTFOHA7ERMITSU&IECTSTHEAPPUCANTTO Z Re-Raof A CIVIL PENALTY OF NOT MORE THAN FIVE MUNORED OOLLARS�f50o).): � OI,ASONMEROfTHEPROPERTV,ORAIVEMPLOYEESWITHWAGESASTHEIR50LECOMPENSATION, � COmfil6lCIBI z WILL DO THE WORIC,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7WI,BUSI� J N NFSS ANO VROFESSIONS CODE:THE CANTMCTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTV WHO BUILOS OR IMPROVES THEREON,AND WHO DOES SUCH WORI(HIMSELF Oq HERSELF OR � � THROUGH HIS OR HEF ONM EAIPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT WTENDED OR m Q OFFERE�FORSALEIF,HOWEVERP7EBUILDWGORWPROVEMENTISSOLDWI7NPlONEVEAAOFCOMPLE- � z TION,7HE OWNER�BUIIDER WILL HAVE THE BUROEN OF PROVPIp THA7 HE OR SHE DIO NOT BUILD OR � N/PiiOVE FOR THE PURPOSE OF SALE). � � w ❑I.AS OWNER OF THE PROPER7Y,AM E%CLUSIVELy CpNTRAGTING VATH UCENSED CONTRACTOiiS Q TO CONSTRUCT THE PRQIECT(SEC.7011,BUSINESS M1D PROFESSIONS CODE THE CONTRACTORS LI� V3IU0�lOf1 '".�C�': !'i:1�.". qpJ.AREq W CENSE UW DOES NOTAPPLV TO M!ONMER OF A PHOPER7Y WHO 9UILD5 OR IMPROVES THEREON,AND Wlq CAMRACTS FOR SUCN PROJECTS WITH A CONTMCTOR�S)LICENSE�PUPSUANT TO THE CONTRAC� �' roas ucENSE uw.�. OUANTITY DESCRIPTION �E Y � ❑I AM E%EMPT UNDER SEC. g.8 P.C.FOR THIS REASON Q ?� U LL OA7E OWNER � � � LICENSED CONTFACTORS DECLAFATION W � � I HEREBY AFFIRN UNDER PENALTY OF PERIURY THAT I AM�ICENSED UNDER 7ROVISIONS OF CHAPTER � � G(COMMENCING WITN SECTION 7000)OF DIVISKKJ 90F THE BUSINESS AND PROFESSIONS CODE,AND z ' �� MY LICENSE 45 W FULL FOFCyE..A,.N�EFFECT. m � LICENSE CLASS �./ IIC.NO. K�1�:`;%��.`�' �,(�'��^• � F-- � V DATE � ' '� 4 E CONTRACTOR � d w - � ' . . t�..J.... ��, , ---'".. � . WORKERS'COMPENSATION DECLARATION " a � I HEqEBV AFFIRM UNDER PENALTY OF PEfYfURV ONE OF THE FOLLOWING DECLARATIONS: U � Z �Z I HAVE AND WILL NAINTAIN A CERTIFICATE OF CONSENT TO SELFdNSURE FOR WORKERS' a Q COMPENSATION,AS PROVIOED BY SECTION 370o OF THE LABOF CODE,FOH THE PERFORMAFICE U OF THE WOFK FOR WHICH THIS PEFMIT IS ISSUED. w O � w _1 HAVE MID WILL MAINTAIN WORKEFiS'COMPENSATION INSURANCE,AS REIX11qED BY SECTION Q 3700 OF THE LABOR CAOE,FOR THE PERFORMANCE OF THE WORK FOR WNICN THIS PERMIT IS ^44^'+Ri. �.. � ISSUED.MV WORKERS'COMPENSATION INSUPANCE CAARIER PND POLICY NUMBER AiiE: ' CO^NSTRUCTION ��:�� ,��;,�„j J � j CARRIER '"'^r''��,.,i� ��'-t h �.1:"� .�c:. ' PLAN REVIEW � POLICV NUMBER � ��'^"'+. �f • ��.�.. ELECTRIC " - � (iFRSSECtqNNE�N0T8E�MPLETmOFhIEPERMrISFpqONEFLrDRmOCl1AR5(f100)OqLESS} PLUMBING w Z I CERTIFV THAT W THE PERFOF/AANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C} SHALL NOT EMPLOV ANV PERSON IN MIY MANNER SO AS TO BECOME SU&IECT TO THE [/� WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME' INSPECTION FEE SUBJECT TO THE WORKERS'COIAPENSATION PROVISIONS OF SECTION�70o pF THE LABOR .-�"""'r-��`--+� �J�.� �' ,.�,_ ~ CODE.I SHALL FORTHWITH COMPLY WITH TI-IOSE Vi70VISIONS. r ISSUANCE � � ) �3 p DATE: i '` �.�:�^ � f� APPLICANE i'S ;' . + n _ �SMIP � - ,..----• v ��.? w Y� � �� ENERGY P/C � WAHNIN4:FAILURETO SECURE WORKERS'COMPENSATION CAVEFlAGE IS UNLAWFU�M1D SHALL BE J � SU&IECTMlEMPLOVERTOCRIMW�LPENALTIESAN�CMlFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLUAS(f loa,000�,W ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PHOVIDED FOR IN � SECTION 3708 OF THE 1A80R CODE.IN7ERE5T,AIJD ATTORNEV'S G'EES. RETENTION FE�:rJ �. t�•� �j �_.......•�'."'...- O CONSTRUCTION LENDING AGENCY . _.. PRE-ALT FEE: � � I HEREBY AFFIRM UNOER PENALN OF PERJURY THAT THERE IS A CONSTRUCTION LENDINO AOENCY i � - � ;� r ¢•'t... `�.ji..:� FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS.PERMIT IS ISSUED(SEC.]091,CIV.C.�. Z • W "' � LENDER'S NAAIE F— LENDERS PDDqESS �-J• ,..1 ,...; y w ICERTIFYTHATIHAVEREADTHISAPPLICATIONANOSTATETHATTNEABOVEWFORAIATIONISCORAECT. TOTAL FEES � � "F ,�� ,� '--� � I AGREE TO CAMPLY WITH ALL CfTY AND COUNTV ORDINlWCES M!D STATE UWS FEUTINO TO BUILDING ' ' � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON TNE -! O � Z ABOVE-MEMqNED FROPERTV FOR INSPECTION 7URPOSES. im p � f COMMENTS V V • � Kd'^�„'�`r��1�3('.. �;� �{:l m PERMITTEE NAME(PRINn � ��1,.?.` �'1, :,f ._...., � . �y.;� . f� . ' . ,' 1 � SIGNATUREOFPERMfrfEE � DATE '/ }'�g r � ,,,,�'r�J f r� � RECPT.NO. --� �� .� PAID BY� _'�j J �I VALIDATION � WHITE—Deparimenl Copy,YELLOW—Finence Capy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—App�icant's Copy .